This application is based upon and claims the benefit of priority from the prior Japanese Patent Applications No. 11-041806, filed Feb. 19, 1999; No. 11-089399, filed Mar. 30, 1999; and No. 2000-018865, filed Jan. 27, 2000, the entire contents of which are incorporated herein by reference.
The present invention relates to a microscope apparatus for performing surgery also using an endoscope.
In recent years, microsurgery which is surgery of a small affected part has been developed and widely used. Therefore, microsurgery has frequently been performed in a variety of medical fields, such as the neurosurgery, otolaryngology and ophthalmology. The microsurgery is performed while observation using a surgery microscope is being performed. In particular, non-invasive surgery has been performed to permit quick rehabilitation after the surgery. In particular, attention is being paid to surgery also using a so-called endoscope for observing a portion (a dead zone) which is invisible during observation using the conventional microscope for surgery.
When a portion to be operated is observed with an endoscope in the neurosurgery, the direction of observation with the endoscope must easily be recognized by an operator.
Moreover, low invasion is required to satisfactorily prevent pressing of the portion in the vicinity of the operated portion when the endoscope is operated. Therefore, when the endoscope is operated while observation is being performed with the microscope for surgery, the operation must be performed such that the position into which the endoscope has been inserted is always confirmed.
There are systems of a type with which an image observed with an endoscope is also displayed in a field of view of a surgical microscope. The systems are disclosed in Jpn. Pat. Appln. KOKAI Publication No. 10-333047, Jpn. Pat. Appln. KOKAI Publication No. 7-261094, Jpn. Pat. Appln. KOKAI Publication No. 62-166310, U.S. Pat. No. 5,601,549 and Jpn. Pat. Appln. KOKAI Publication No. 8-131455. The surgical microscope disclosed in Jpn. Pat. Appln. KOKAI Publication No. 10-333047 has a structure that an image observed with an endoscope is simultaneously displayed in an upper region of an image observed with a microscope.
The endoscope for use in the conventional surgical microscope is arranged to illuminate a portion observed with the endoscope or a portion taken by a solid-state image sensing device. To perform illumination, a special light source unit disposed individually supplies light to the endoscope through a light guide fiber.
A surgical microscope for use in an ophthalmic surgery is known which has a structure as disclosed in Jpn. UM. Appln. KOKAI Publication No. 4-83223. That is, a light source provided in a frame for a surgical microscope supplies light to a probe for illuminating the inside portion of the eye so that the inside portion of the eye is illuminated.
The conventional system disclosed in Jpn. Pat. Appln. KOKAI Publication No. 10-333047, Jpn. Pat. Appln. KOKAI Publication No. 7-261094 and Jpn. Pat. Appln. KOKAI Publication No. 62-166310 must have the special light source for the endoscope. Therefore, the cost of the endoscope system cannot be reduced. Moreover, a carrier, such as a cart, is required to mount the light source in the operation room. Thus, the usable space in the operation room is undesirably reduced. Since the light source unit cannot be sterilized, the light source unit must be disposed sufficiently apart from the portion to be operated. Hence it follows that a long light guide fiber for connecting the endoscope and the light source to each other is required. Moreover, the deadweight of the light guide fiber and insufficient flexibility of the same inhibit a smooth operation using the endoscope. As a result, there arises a problem in that the endoscope cannot smoothly be moved during the operation.
The apparatus disclosed in U.S. Pat. No. 5,601,549 is arranged to adjust a direction of observation using a hard scope. Thus, undesirable introduction of the distal end of the hard scope into the shadow of an organization, such as the blood vessel or the nerve, is prevented. At this time, the direction of the diagonal observation in the observation field of view of the microscope cannot easily be detected. Thus, there arises a problem in that the orientation of the observation, such as the direction of observation with the hard scope with respect to the observation field of view of the microscope, cannot be recognized.
The invention disclosed in Jpn. Pat. Appln. KOKAI Publication No. 8-131455 incorporates a hard scope integrally joined to a surgical microscope body. Moreover, a focal-plane plate is provided which has an index (an arrow) formed at an intermediate image forming point of the microscope by stamping. The hard scope and the focal-plane plate are connected to each other through gears, the reduction ratio of which is 1:1. Thus, the focal-plane plate can be rotated to correspond to the rotation with respect to the observation optical axis for changing the diagonal observation of the hard scope. As a result, the direction of observation with the hard scope with respect to the observation field view of the microscope can be detected. However, selection of a variety of hard scopes is inhibited which are different in the size and the oblique observation angles to correspond to the size of a cut portion of the operated portion and a required direction of observation with respect to the direction in which the hard scope is inserted. What is worse, insertion of the hard scope from an arbitrary direction into the portion to be operated in the observation field of view of the microscope is not permitted.
The surgical microscope disclosed in Jpn. UM. Appln. KOKAI Publication No. 4-83223 has the structure that the light source for the surgical microscope supplies light to the probe for the inside portion of the eye. Therefore, any special light source is not required. Light for the surgical microscope and light for the probe for the inside portion of the eye are supplied from one light source by switching light from the light source lamp. Therefore, the surgical microscope and the probe for the inside portion of the eye cannot simultaneously be illuminated. As a result, required observation cannot be performed.
In view of the foregoing, an object of the present invention is to provide an apparatus by improving a conventional surgical microscope so as to enhance the surgery efficiency.
Specifically, an object of the present invention is to provide a surgical microscope apparatus which is capable of eliminating complex routing of a long cable of an auxiliary observation unit to perform microsurgery which also uses the auxiliary observation unit.
Another object of the present invention is to provide a surgical microscope with which sterilization in the vicinity of the microscope can reliably be realized when the auxiliary observation unit is used in the vicinity of the microscope.
Another object of the present invention is to provide a low-cost system which enables simultaneous illumination and observation of both of a surgical microscope and an endoscope to be performed when surgery also using the endoscope is performed to improve the operability of the endoscope and provides a sufficiently large space for an operator and satisfactory large spatial margin in the operation room.
Another object of the present invention is to provide a hard scope to be inserted into the body cavity to enable a surgeon to observe an object in the cavity through a surgical microscope, in a predetermined angular direction in a plane perpendicular to a line along which the hard scope is inserted, and to understand easily the direction of observation in the observation field of surgical microscope.
To achieve the foregoing objects, according to one aspect of the present invention, there is provided a surgical microscope apparatus comprising: a frame portion placed on a floor; a surgical microscope body incorporating a stereomicroscope optical system for stereoscopically observing a portion to be operated and an outer surface; and an arm portion supported by the frame portion to suspend the microscope body at a position apart from the frame portion. The microscope apparatus incorporates an endoscope for observing a blind spot of an observation field of view of the stereomicroscope optical system; a light source unit provided in the frame portion and emitting light for illuminating a portion which is observed by the endoscope; and light supply means having an end which can optically be connected to the endoscope to be capable of supplying light from the light source unit to the endoscope; an image control unit provided in the frame portion and arranged to process an observed image of an observed portion obtained by the endoscope; image transmission means having an end for interfacing the endoscope with the image control unit and capable of transmitting the image observed by the endoscope to the image control unit; and a connecting portion of the endoscope provided on the outer surface of the microscope body and incorporating ends of the light supply means and the image transmission means.
The surgical microscope incorporates the surgical microscope body provided with the connecting portion for the endoscope for sub-observing the blind spot for the surgical microscope. Therefore, distance for which a cable of the endoscope is routed can be shortened. Thus, the operation is not obstructed by the cable. As a result, a surgery efficiency can be improved.
It is preferable that a holding portion for detachably holding the endoscope in the vicinity of the microscope body is provided. In the foregoing case, removal of the endoscope from the holding portion permits immediate use of the endoscope. After the operation using the endoscope has been completed, the endoscope is joined to the holding portion. Thus, the endoscope can quickly be put back, causing the operation to smoothly be performed. It is preferable that the holding portion is provided for one casing together with the connecting portion.
It is advantageous that the surgical microscope apparatus further comprising: a sterilizing drape for covering the surgical microscope body to realize a sterilized state in the internal body portion, wherein the holding portion incorporates a holder having a joining portion arranged to be joined to the surgical microscope body from outside of the sterilizing drape and an accommodating portion for accommodating the endoscope, and the joining portion and the accommodating portion of the holder are spatially separated from each other. In the foregoing case, the sterilizing drape is not ripped when the observing means is joined or removed. If the joining portion rips the sterilizing drape, the sterilization of the auxiliary observation means can always be maintained because the joining portion and the accommodating portion are spatially separated from each other.
An ultrasonic probe may be employed as a substitute for the endoscope or the same may be employed together with the endoscope to observe the blind spot of the observation field of view of the stereomicroscope optical system.
In the foregoing case, the surgical microscope apparatus further comprises: a drive unit provided for the microscope body and arranged to produce a drive control signal for an ultrasonic oscillator provided for the ultrasonic probe; a relay portion for relaying an ultrasonic signal transmitted from a portion observed by the ultrasonic probe; a drive signal transmission portion for transmitting (interfacing) the drive signal to the ultrasonic probe; an ultrasonic signal transmission passage for transmitting the ultrasonic signal from the ultrasonic probe to the relay portion; and an ultrasonic probe connecting portion provided for the outer surface of the microscope body and capable of connecting the drive signal transmitting portion and the drive unit to each other.
According to another aspect of the present invention, there is provided a surgical microscope apparatus comprising: a frame portion disposed on a floor; a stereomicroscope optical system for stereoscopically observing a portion to be operated; a surgical microscope body having an outer surface; an arm portion supported by the frame portion and structured to suspend the microscope body at a position apart from the frame portion; an auxiliary observation unit for observing a blind spot of an observation field of view of the stereomicroscope optical system; an operating/control unit provided for the frame portion and arranged to operate the auxiliary observation unit; cable means extended from the operating/control unit through the arm portion and having an end disposed in the microscope body; a connecting portion for forming an interface between the auxiliary observation unit and the operating/control unit; a holding portion joined to the microscope body and detachably holding the auxiliary observation unit; a holding casing for integrally holding the connecting portion and the holding portion; and moving means provided for the holding casing and arranged to move either of the connecting portion or the holding portion with respect to the microscope body.
It is preferable that the microscope body incorporates a housing, the moving means has a hollow shaft portion provided for the holding casing and arranged to penetrate the housing and the holding casing is, by the shaft portion, rotatably supported with respect to the housing. In the foregoing case, the auxiliary observation unit can be disposed at a position at which an operator can easily handle the auxiliary observation unit.
Alternatively, the holding casing may have a joining portion detachable with respect to the microscope body. In the foregoing case, it is advantageous that the microscope body has a housing, either of the housing or the joining portion has a dovetail groove, and the other element, which is the housing or the joining portion, has a dovetail which slidably engages to the dovetail groove.
When the auxiliary observation unit is an endoscope, it is preferable that the surgical microscope apparatus incorporates another light supply means for supplying light from the light source unit to the portion to be operated; and light branching means for branching the light supply means capable of supplying light to the endoscope from the other light supply means.
In the foregoing case, simultaneous illumination to both of the surgical microscope and the endoscope is permitted when an operation also using the endoscope is performed. That is, field of views can simultaneously be observed by both of the surgical microscope and the endoscope. Since light can be supplied from a common light source unit to the surgical microscope and the endoscope, a special light source unit for the endoscope is not required. As a result, the structure can be simplified and, therefore, a low-cost apparatus can be provided. Moreover, a cart or the like for mounting the light source unit in the operation room is not required. Hence it follows that a wide space can be provided in the operation room. Since the light supply means required to only connect the endoscope and the microscope to each other can be shortened, deterioration of the operability of the endoscope owing to the deadweight and unsatisfactory flexibility of the light supply means can be prevented. Moreover, the operation of the operator is not obstructed and a sufficiently large working space can be provided.
In the foregoing case, the light branching means may comprise light passage splitting means composed of a group including a half mirror, a beam splitter and a split light guide fiber; or a light passage reflecting means composed of a group including a prism and a mirror.
It is preferable that the endoscope incorporates an elongated hard insertion portion having an axial line and a distal end which is inserted into the body along the axial line; an objective optical system provided for the distal end and having an optical axis which extends to make a predetermined angle with respect to the axial line; and identifying means provided for the distal end and indicating a direction in which the optical axis of the objective optical system extends, wherein the identifying means can stereoscopically be observed through the stereo-microscope optical system.
In a case of the foregoing surgical microscope, the operator attempts to use both of enlargement observation of a portion to be operated and observation of a blind spot portion for the observation with the microscope by using the hard scope, which enables the correlation of the position of observation performed by using the hard scope with respect to the field of view for the microscope to easily be recognized even during the observation using the microscope. Therefore, the objective lens of the hard scope can easily be moved to a desired position in the blind spot portion for the observation using the microscope. Moreover, any expensive apparatus is not required to realize a similar effect if the conventional hard scope is slightly changed or additional parts are added to the same.
The identifying means may be formed by at least one index provided for the outer surface of the distal end, an outer shape provided for the distal end and either of a portion to be operated and the endoscope joined to the endoscope.
Alternatively, the identifying means may have a projecting unit for projecting an index to at least either of the portion to be operated or the outer surface of the endoscope. The projecting unit may have a laser diode. The projecting unit may be made detachable with respect to the endoscope.
Additional objects and advantages of the invention will be set forth in the description which follows, and in part will be obvious from the description, or may be learned by practice of the invention. The objects and advantages of the invention may be realized and obtained by means of the instrumentalities and combinations particularly pointed out hereinafter.